Third Party Influences on Care

In a number of papers I have explored the dilemmas that are created when there is a clash of ethical frames of reference. In particular, the health professional can face conflicts between the needs of their employers and those of their clients. Essentially this can be expressed by the Upton Sinclair quip: “It is difficult to get a man to understand something, when his salary depends upon his not understanding it.”

The ‘third party’ focus essentially brings a sociological lense to the problem of ethics.  Most ethical reasoning is expressed with a bias for the individual as the locus of agency in interpreting everyday life and the behavior of others. We tend to seek internal, psychological explanations for the behavior of those around us while making situational excuses for our own. This is such a common way of looking at the world that social psychologists have a word for it: the fundamental attribution error.

When someone wrongs us, we tend to think they are evil, misguided or selfish: a personalized explanation. But when we misbehave, we are better at recognizing the external pressures on us that shape our actions: a situational understanding. If you snap at a coworker, for example, you may rationalize your behaviour by remembering that you had difficulty sleeping last night and had financial struggles this month. You’re not evil, just stressed! The coworker who snaps at you, however, is more likely to be interpreted as a jerk, without going through the same kind of rationalization. This is convenient for our peace of mind, and fits with our domain of knowledge, too. We know what pressures us, but not necessarily others.

The dilemmas I have written about in these papers articulates the sociological framing as a series of case studies. I have also examined the ways that the needs of informal carers can clash with those of the person they are caring for. This provides a nuanced way of examining a concept that is frequently articulated as the ‘burden’ of caring. This is one of the areas that I receive repeated invitations to speak.


Butler, M (2014) “What doesn’t kill us makes us stronger”: the influence of third parties on care ethics. Invited talk at the “Cosmopolitan Anthropologies – Combined ASAANZ/AAS conference” 10-13 November, Millenium and Copthorne Hotels, Queenstown

Butler, M. (2014) Ethical Reasoning and Third Party Influences on Practice  in Pain: A Public Health Problem.  The 39th Annual Scientific Meeting. Combined Physiotherapy and Occupational Therapy Meeting. 20 – 23 March 2014, The Town Hall, Dunedin, New Zealand

Butler, M. (2012) Ethical reasoning: internal and external morality for occupational therapists. Clinical reasoning in occupational therapy: Controversies in practice. L. Robertson. London Wiley Blackwell.